This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Friday, 17 December 2010

A Letter from the RCN

From Peter Carter:

"Last week we wrote to you with news of an important proposal from the NHS in England.

Despite already imposing a two year pay freeze, the NHS in England has now told the RCN and other NHS trade unions that there isn't sufficient money to pay increments for any NHS staff for up to two years. In exchange for a total increment freeze, the NHS are offering a guarantee of no compulsory redundancies for some staff.

Yesterday, RCN Council held a meeting to discuss the proposal. This email is to tell you about that discussion and to set out the next steps.

RCN Council examined the proposal in great detail. We need to be clear that Council will not accept or reject the proposal until you and every other RCN member has had the opportunity to share your views. However, Council wanted me to share with you their initial thoughts.

Council were unanimous in their opinion that the proposal does not offer any kind of guarantee for nursing staff and that, if implemented, it could signal the end of national terms and conditions through Agenda for Change which the RCN fought so hard for.

Although the proposal sets out a guarantee of no compulsory redundancies for those on bands 1-6, this will only apply in trusts that decide to opt-in and will involve local discussions and agreement.

RCN Council also believe that, in reality, the vast majority of nurses are not facing this threat. Instead, the real danger to patients and services comes from the tens of thousands of posts which are set to be cut through recruitment freezes and deleting vacant posts.

To give up any prospect of career progression in exchange for a measure that does not guarantee staffing levels, not to mention job security for all nursing staff, will understandably anger many of you. We also know that an increment freeze will have a real financial impact at a time when VAT is set to rise, the cost of living is going up and pension contributions are increasing.

So what happens next?

Council have asked me to start the process of discussing the proposals with our sister unions in the NHS. We also need more information from the NHS in several key areas:

What is the funding gap that decision makers are trying to bridge?

What other savings are planned, and how will they be achieved?

If NHS staff are expected to accept yet another restriction on their pay, what else is being done to save money?

How many jobs are at risk, and how many would be avoided through the guarantee?

How can Foundation Trusts, who have autonomy over their own pay agreements, guarantee no compulsory redundancies?

The guarantee only extends to staff between bands 1-6, what about the thousands at bands 7-9?

Let me be clear. Asking for this information does not mean that we are 'negotiating' on the proposal at this stage. It simply means that we need to have all the information in order to share it with you, our members, so you can have all the facts before you tell us your views. I wish to assure you that, ultimately, it will be you, our members, who accept or reject this offer.

We are your union, your voice for nursing and we will act in your best interests and those of your patients.

Over the next few weeks we will be sharing news with you about our consultation process, in the meantime, please do carry on telling us your views through your branches and boards, your Council members, through the Frontline First website, via the the RCN's Facebook page or by emailing us at frontlinefirst@rcn.org.uk.

Thank you to all those who have shared your thoughts already. We wish to assure you that we are listening to each and every comment.

Yours sincerely,

Dr Peter Carter

Chief Executive & General Secretary

P.S. You can find out more about the terms of these proposals by watching this video: http://frontlinefirst.rcn.org.uk/pay-proposal"

Maybe a glimmer of hope if the other unions decide that there is safety in numbers and call for a national strike?Mark my words, its this sort of behaviour (under the last tory government) that caused a mass exodus of nurses from the UK- I was one of them along with many of my friends.if you are old/frail/sick....be very afraid.

I met Peter Carter last year at a student thing to get more student members. He doesn't really have much to say of any importance but every RCN advisor / branch lead or whatever they call themselves look up to Peter Carter as if he is some god of nursing rights. Let's not forget he is infact just another manager in Nursing. He was at one point calling himself Dr Carter, god knows where he got that title from and why he does not call himself that anymore. He was also the driving force behind the surge of HCA's and "Cadets" in the NHS.

It will be interesting to see how this will impact graduates, well it wont be interesting, more obvious, there will be yet again less jobs for graduates and hospitals up and down the land for any newly-qualified staff, that with the 10% cut in student nurse numbers in scotland and the even bigger cuts universities are making each year (my school cut 10% of student numers last year and 12% this year) means there will be no jobs and eventually, not enough newly-qualified nurses even if there were any jobs! I suspect along with this proposal now more specialized services will deeply suffer first, and then more general areas like elderly medicine and geriatirc care that have infact been suffering for years. Every NHS service out there will be in the gutter, particually nurse-led services.

How much tighter are they going to make the noose before every nhs trust out there begins to choke? A department I was in for my second placement which is very nurse-strong is being cut back, in the meantime they are bringing in 1 new consultant and 2 reg posts due to the closure of 2 satalite units and more patients than ever will be walking through their doors in april/may time. The A&E department I used to work in haven't advertised for a band 5 or 6 for months and months and 3 inside the department are about to go on long maternity leave. The first placement I was on which is a acute stroke have just lost 2 nurses and replaced them with 1 HCA. It's turning into one big fucking joke all over the country.

Essentially, it will be the same story over, patients will suffer, and potentially die from the lack of care and resources needed. Another fiasco like in staffs will likely occur. How many dead patients and throttled services do these wankers in government and upper-management in the NHS need before they realise their money-making excercise in theory looks brilliant and in practice is deadly?

He has a PhD, so is entitled to call himself "dr". its only the UK that gets its knickers in a twist when non-medics with PhDs quite rightly do this.That said, he hasn'r practised as a clinical nurse in decades (much like the rest of the RCN) and is hopelessly out of touch. I met him once and asked about staffing levels and skill-mix in the future. He sidestepped the question, as he also did about strike action. Sucking up to the powers that be is a preresquisite for a union offical...

Some redundancies. Maybe some. I've spent three and a half years (had a blip in the middle) in abject poverty, and now the end is in sight and I've found myself a job I'm going to be stuck at the bottom. So in two years, when I've done my PREP, to ensure I'm a safe and up to date practitioner there will be brand new staff climbing the ladder at exactly the same rate as me, with less experience on the same money, that I will no doubt be expected to be a preceptor for.

Lets face it, if increments are frozen now then they will never come back. There is a lovely little get out clause in the foundation trust manifesto that allows them to set their own payrates, if they so choose. To date, none have bothered as there has been no point. Now its been handed to them on a plate. watch this space, by 2015 the NHS will no longer employ RNs- the foundation trusts that survive the current financial mess will become fully fledged private hospitals that cater for elective treatments only. Some of the biggest ones will opt to take truama and ICU will be lumped in with this as the two go hand in hand. You can make a profit out of trauma if you have a captive market- ie only a few centres will take patients. These private hospitals will be the only one to employ RNs and may or may not provide better working conditions. Insurance will become the norm. Anyone with a chronic (mainly medical) condition will be left to the mercy of the "improved" NHS. This will consist of the failed trusts who now only employ HCAs/APs on the wards. Doctors etc will only work here in exchange for payments towards their student loans...this is the county system in the US- few doctors choose to work in these hellholes (believe me, I have first hand experience-most of the RNs were like me, from Europe). This is where we are heading Dr Carter , unless we DO SOMETHING ABOUT IT.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.